Physicians Avoid Conversations About Religion in the ICU

Religion and spirituality are not common topics of discussion in intensive care units (ICUs), and doctors often go out of their way to avoid them—even though religion is often very important to patients and their medical surrogates during end-of-life care, a new study shows.

In the study, published Monday in the journal JAMA Internal Medicine, researchers listened to audio recordings of 249 meetings between surrogates of critically ill patients and health care professionals in 13 different ICUs across the country. The goal was to investigate the religious or spiritual content in these talks. The researchers found that although religion was considered important to 77.6% of the surrogates (a surrogate is a family member or another person responsible for making medical decisions for a patient), conversations about religious and spiritual topics occurred in less than 20% of the goals-of-care conversations. Health care professionals rarely “explored the patient’s or family’s religious or spiritual ideas.”

When conversations about spirituality did occur in some of these end-of-life care conversations, the researchers found that 65% of the time the topic was initiated by the surrogate. Health care professionals raised the issue of spirituality only 5.6% of the time.

The types of religious conversations surrogates would bring up fell into categories such as: referencing their religious or spiritual beliefs, having the notion that the physician is God’s tool to aid in the healing of their loved one, and the idea that the end of life would be a new beginning. For example, surrogates said things like, “All I can do is pray for her to continue to get better and maybe one o’ these days, she can walk outta here.” Or, “I’m very, very optimistic because I know our faith is strong.”

The most common response among health care providers when a surrogate brought up religion or spirituality was to change the subject. In only eight conferences did a health care professional try to understand the beliefs of the surrogate by doing things like asking about the patient’s religious beliefs. “Our findings suggest that religious considerations—viewed as important to a large proportion of Americans—are often absent from end-of-life conversations,” the authors wrote. “This may signal a need for changes in health care delivery in ICUs.”

The study authors concluded that one potential solution would be to “redesign” health care processes so that spiritual care providers were a larger part of end-of-life care discussions for patients who value spirituality and religion.

In a corresponding editorial, health care professionals who were not involved in the study wrote: “Although we health care professionals struggle to connect spirituality and medicine as evidenced by the many and mounting articles that refute or explicate their connection, our patients and families typically do not struggle. For most, thoughts of what is most sacred, of what transcends the finitude of human life, come flooding in the moment the physician shares the news of the serious illness or the telephone call comes urging the listener to the bedside of a critically ill loved one.”

The new study suggests that religion and spirituality may be a conversation that people want to have at the end of life, and they are not getting it from their health care providers. Finding a solution for this discrepancy could be in patients’ and health care professionals’ best interest, the editorial said.